Abstract
In this paper we argue that austerity creates working conditions that can undermine professionalism in healthcare. We characterise austerity in terms of overlapping economic, social and ethical dimensions and explain how these can pose significant challenges for healthcare professionals. Amongst other things, austerity is detrimental to healthcare practice because it creates shortages of material and staff resources, negatively affects relationships and institutional cultures, and creates increased burdens and pressures for staff, not least as a result of deteriorating public health conditions. After discussing the multiple dimensions of austerity, we consider the challenges it creates for professional ethics in healthcare. We highlight three mechanisms—intensification of work, practitioner isolation, and organisational alienation—which pose acute problems for healthcare professionals working under conditions of austerity. These mechanisms can turn ‘routine moral stress’ into moral distress and, at the same time, make poor care much more likely. While professionalism clearly depends on individual capabilities and behaviours, it also depends upon a complex sets of social conditions being established and maintained. The problems caused by austerity reveal a need to broaden the scope of professional ethics so that it includes the responsibilities of ‘role constructors’ and not just ‘role occupiers’. Austerity therefore presents opportunities for health professionals and associated ‘role constructors’ to contribute to a reimagining of future models of healthcare professionalism.
Highlights
This paper examines how the regime of fiscal austerity seen in the UK since 2010 has created working conditions for healthcare professionals that pose significant challenges for professional ethics
We have argued that the economic, social and ethical dimensions of austerity create highly problematic conditions for healthcare professionals to operate within
Austerity can turn the routine moral stress that has always accompanied the work of healthcare practice into forms of moral distress
Summary
This paper examines how the regime of fiscal austerity seen in the UK since 2010 has created working conditions for healthcare professionals that pose significant challenges for professional ethics. ‘starry-eyed’, about healthcare professionals they might, in relatively affluent health systems, reasonably expect conditions to be available that enable them to: (a) routinely provide threshold levels of adequate treatment and care; (b) have some capacity to identify and aim for high standards of treatment and care through, for example, (contributing to or harnessing) research and innovation; (c) work in an environment that supports effective teamwork and enables professional development including peer learning and support, and (d) have some time and space available to them to come to terms with, and help enact, evolv‐ ing models of good practice. If this possibility is substantially reduced, or completely removed, so that workers can no longer live up to their idea of what it means to occupy and execute their professional role, their thoughts of leaving the profession are understandable, not least as a means of maintaining a vestige of personal (and professional) integrity [32]
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